| NPI | 1992233001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 7159) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 10387168) |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2019-05-23 |